Filter by Country

Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Gerard CangelosiUniversity of WashingtonSeattle, Washington, United States

Grand Challenges Explorations

Diagnostics Systems

1 May 2018

Gerard Cangelosi of the University of Washington in the U.S. will develop reagents to visually validate oral swabs and stabilize them for storage and transport to diagnostic laboratories in low-resource settings without the need for a cold chain. Oral swabbing to extract saliva is a non-invasive and effective method for diagnosing tuberculosis, and is faster and safer than traditional sputum collection. However, it is more difficult to review the quality of a swab sample as they are hard to see, and processing currently requires refrigeration. To address these limitations, they will develop a low-cost, quality control test with chemical reagents for detecting human mitochondrial DNA using human oral swabs from U.S. volunteers spiked with an avirulent strain of Mycobacterium tuberculosis. This will be coupled to a visual fluorescent readout that can be used to distinguish adequate from inadequate samples. They will also test different buffers for their ability to stabilize the swab samples at different temperatures for up to six months.

Guitele RahillUniversity of South FloridaTampa, Florida, United States

Grand Challenges Explorations

Maternal Mental Health

1 May 2018

Guitele Rahill and Manisha Joshi of the University of South Florida in the U.S. will harness the Haitian tradition of storytelling to produce online videos, brochures, and posters that support pregnant teenagers in Haiti who are at high risk of depression. There has been an increase in unplanned teenage pregnancies since the 2010 earthquake, due in part to the loss of parents, and a rise in transactional sex and sexual assaults facilitated by very limited resources. Pregnancy places a substantial additional stress on these children, which in turn causes long-term difficulties for their children. In Haiti, to tell a story you announce "Krik?", and to hear it you respond "Krak!" They will use this familiar story-telling framework and actors who resemble the target group to teach pregnant teenagers about childbirth, motherhood, and how to cope with depression. They will conduct two focus groups of six pregnant teens to identify the specific challenges they face, and use their feedback to help ensure the approach will work.

Dyuti Sen and Tushar Garg from Innovators in Health in India will test whether a communal game of snakes and ladders in maternity health clinics and in homes of pregnant couples can demonstrate the value of childhood immunization to improve coverage in rural communities in Bihar, India. Gameplay may be a valuable way of informing parents about the importance of immunizing their children because it is fun and interactive. Snakes and ladders, which is a popular game in India, can also visually illustrate the positive (ladder) and negative (snake) effects of immunization, such as the economic cost of having a sick child. The board is built up interactively by the parents as they make choices about vaccinating their children from the start (newborn) to the finish (fully protected child). They will train community health workers to facilitate communal games of snakes and ladders, trial their approach in around 15 municipal wards over 12 months, and determine its impact on immunization coverage and local knowledge.

Chiwoneso TinagoWest Chester University of PennsylvaniaWest Chester, Pennsylvania, United States

Grand Challenges Explorations

Maternal Mental Health

1 May 2018

Chiwoneso Tinago of West Chester University of Pennsylvania in the U.S. will partner with adolescent mothers and local health workers in Zimbabwe to create peer-support groups incorporating cellphone-based technology such as the WhatsApp messenger application to provide coping and parenting skills to improve the mental health of young mothers. Young mothers less than 18 years old in Zimbabwe are often socially isolated due to forced marriages and exclusion from school, and therefore have no help when bringing up their children. This leaves them vulnerable to physical, emotional, and mental health problems, which also harms their children. They will hold one-hour focus groups with around 100 adolescent mothers and other community members including health workers and teachers, to identify the important topics and the best set-up for the support group meetings. They will then train community health workers and educators to run the peer-support groups, and evaluate its effect on depression and anxiety.

Agnes Ronan, from Pediatric Adolescent Treatment Africa, in South Africa will develop a training and supervision tool for young health workers that combines screening and support in an accessible format to reduce depression in HIV-positive, adolescent mothers. There are an estimated two million adolescent mothers living with HIV in Africa, and stigma prevents many of them accessing health care. Young HIV-positive peer supporters work in local clinics and use informal chats, text messages, and home visits to support HIV-positive adolescents. However, they lack the skills to support the mental health of HIV-positive adolescent mothers. They will adapt existing cognitive behavioral therapy methods based on the WHO's Thinking Healthy program, and co-develop their approach with adolescent mothers, peer supporters, and developers. They will train 70 peer supporters from six southern African countries and each will recruit three HIV-positive adolescent mothers to test the approach.

Gershim AsikiAfrican Population and Health Research CenterNairobi, Kenya

Grand Challenges Explorations

Immunization Delivery

1 May 2018

Gershim Asiki of the African Population and Health Research Centre in Kenya will develop a mobile phone application and centralized electronic database to link birth records with immunizations to increase the coverage of BCG and polio vaccines in newborns in Kenya. Births and immunizations are initially recorded on paper and then transferred to separate electronic databases, meaning that many infants fail to receive the standard vaccinations on time. They have developed an integrated database that collects both birth and immunization data directly from nurses and health workers via mobile phones. They will evaluate the feasibility of their approach by registering around 450 newborns from an urban slum, and train community health workers to register pregnancies, due dates and delivery dates using the mobile phone application. They will monitor the newborns up to two months after birth, and test the effect of their approach on the timeliness of vaccinations.

Jan Willem Alffenaar of the University Medical Center Groningen in the Netherlands will develop two simple tests that measure the concentration of anti-tuberculosis drugs in treated patients in low-resource settings in order to optimize dosage and limit the emergence of deadly multi-drug resistant Mycobacterium tuberculosis (MDR-TB). The increased incidence of MDR-TB is due in part to low levels of anti-tuberculosis drugs, thus dosage optimization during treatment is important. However, doing this in low-resource settings is currently challenging. They will develop a method for use in Tanzania to measure the concentration of the anti-TB drug fluoroquinolone in saliva using a battery-operated UV spectrophotometer. They will also modify a high-performance liquid chromatography (HPLC) platform for detecting drug concentrations in dried blood spots, which are collected on filter paper and do not require refrigeration to remain stable. The on-site saliva test will allow detection of patients with too low levels of drug at risk for treatment failure, who can then have their dose optimized following the more detailed dried blood spot analysis at a centralized laboratory.

Folusho BalogunUniversity of Ibadan, College of MedicineIbadan, Nigeria

Grand Challenges Explorations

Immunization Delivery

1 May 2018

Folusho Balogun of the University of Ibadan in Nigeria will train older women who are traditionally involved in childcare in Nigeria to ensure infants in their communities are fully immunized. Many young children in Nigeria, particularly those in urban slums, are not fully immunized, or are immunized too late, leading to an unacceptably high under-five mortality rate. This is due in part to the mothers not understanding how critical immunizations are. In many African nations, the care of young children is also overseen by older women in the community such as grandmothers or neighbors. They hypothesize that training these older women to be formally involved in promoting immunizations will help to ensure all children complete the full package on time. They will select five urban slum communities in southwest Nigeria and use focus group discussions to explore the views of the older women on current immunization programs. They will use this to design a manual to train a group of older women who will be associated with pregnant women in the community, and evaluate the effect on immunization of the infants up to nine months.

Jerome Ateudjieu of Meillerur Acces aux Soins de Sante in Cameroon will test whether training community volunteers to record demographic movements and monitor births and immunizations of residents and visitors in their villages can improve timely childhood vaccination coverage in Cameroon. Many health districts in Cameroon have reported outbreaks of vaccine-preventable diseases. One underlying cause is that many people in these regions travel extensively, making it difficult for health facilities to identify newborns that need vaccinating, and to inform parents when and where the necessary vaccinations can be received. They will select 60 villages in the Noun Health District of West Cameroon, and train community volunteers to record the movements and immunization status of infants up to 11 months in their village. These records will be sent by the WhatsApp mobile messaging application to the relevant health facility to identify the children eligible for the next immunization session. The necessary appointments will then be communicated back to the parents by the community worker, who will also inform them of the importance of timely immunization, and encourage pregnant mothers to give birth in health facilities.

Arun Shanbhag of Manipal University in India will use near field communication (NFC) tags to transform traditional bracelets worn by infants in India into portable vaccination records that better track particularly migrant communities to promote full childhood vaccination coverage. Vaccinations are recorded on paper, which are easy to lose and make it difficult for health workers to monitor children in migrant communities. They created beaded bracelets that can store vaccine records on a digital tag, and have developed a mobile application that can read the tag using an Android smartphone. In consultation with local communities, they have also developed a universal color code for the beads to represent the required individual vaccines so that they can be easily monitored by health workers. They will now evaluate their approach in a larger study across five villages to assess its overall performance including the stability of the records over time, data storage capacity, the effect on vaccination coverage, and ease of use.